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39 Cards in this Set
- Front
- Back
What is evidence based practice? |
Taking into account the best available research evidence and patient values and choices. Using clinical expertise. |
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Key points of evidence based practice |
1.) Expert opinions may be wrong 2.) A trial is the best way to identify effective treatment 3.) Dangerous just to rely on animal studies, observational studies and trials of surrogate outcomes 4.) Do not allow current opinion, bias and enthusiasm for treatment cloud judgement 5.) Be careful in deciding if causal relationship 6.) Require evidence from well designed, conducted and reported randomised controlled trials |
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Define exposure |
Possible determinant of health |
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Define outcome |
Health status |
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Define population |
A group of people with similar a similar characteristic |
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What is descriptive epidemiology? |
It involves describing patterns of health and disease, the impact of disease and trends across time. |
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What are the 3 measures of occurrence? |
Prevalence, cumulative incidence and incidence rate |
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Define prevalence |
The proportion of people in a population who have the exposure/outcome at a particular point in time. "Snapshot" |
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What is the equation for calculating prevalence? |
P= number of existing cases / total population at risk ....at time t (MUST GIVE TIME) |
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Interpretation of prevalence measure |
The prevalence of the exposure/outcome in the population at time point/event was value. |
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What are the limitations of prevalence measurements? |
Prevalence is influenced by the duration of the disease, doesnt look at causes |
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Define the general term incidence |
The occurrence of new cases of an outcome in the population during a specific period of follow up |
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Define cumulative incidence |
The proportion of an outcome-free population that develops the outcome of interest in a specified time period |
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What is the equation to calculate cumulative incidence? |
CI= new cases during time period/population at risk in the beginning |
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Interpretation of cumulative incidence |
The cumulative incidence of outcome in the population during the time period was value. |
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Limitations of cumulative incidence |
1.) Assumes closed population (no one leaving or entering) 2.) Highly dependent on the time period - the longer the time, the higher the incidence (numerator) while the same population (denominator) |
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Define incidence rate |
The rate at which new cases of the outcome of interest occur in a population (average speed of new cases) |
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At what point in a study do people stop being 'at risk'? |
When they are lost to follow up, develop the disease/become a case, are not able to develop the disease (ie: women and prostate cancer) or the follow up time ends |
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What is the equation to calculate incidence rate? |
IR = number of new cases during the time period/ total person time at risk of becoming a case |
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Interpreting incidence rate |
The incidence rate of outcome in the population was value cases per value person years/months/days etc Dont need time period as already included in rate, also often have to simplify eg: 0.5 cases per 1 person-year or 50 cases per 100 person-years |
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Incidence rate limitations |
1.) can get very complicate to calculate 2.) Person-time is often not available |
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Advantages of using incidence measures of occurrence rather than prevalence |
1.) Not dependent on disease duration 2.) Measuring development of disease rather than those that have disease |
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What is age standardisation? |
It is a method to make 2 groups have the same age distribution. This allows measures of occurrence to be compared between different populations. It removes age as a confounder and is important as most diseases are age related. |
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When is age standardisation used? |
It is used when you want to compare measures of occurrence between 2 populations but the age structures are different and disease risk varies with age. |
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What do dental epidemiologists study? |
Dental carries (decay), periodontal (gum) disease, malocclusion (crooked teeth), tooth loss, enamel defects, mucosal lesions, dry mouth |
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What is the major difference between dental epidemiology and general epidemiology? |
General = commonly make 1 observation per person Dental = make many observations per person |
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Most oral diseases can be described as... |
Common, age related, chronic, progressive and irreversible. |
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Where can we find health/disease inequalities? |
International, generational, age, area, income, ethnicity, education, disability |
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Where can we find treatment or lack of inequities in dental care? |
Filling vs cavity, composite vs amalgam, extraction vs root canal, implant vs denture, gold vs ceramic crown, budget vs boutique, publicly funded vs private, emergency vs routine, preventative vs interventive |
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Describe generational/age based dental inequality |
Over generations, average oral health status decreases. The older the person, the more likely they are to have decayed, missing or filled teeth |
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Describe the ethnic inequality in dental care |
Maori almost 2x more likely to have missing teeth than non-Maori |
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Describe disability based inequality in dental care |
People with intellectual disabilities are more likely to have poor oral health and untreated oral diseases |
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Compare inequality in disease and treatment in dental care |
Inequality in the way treatment is provided is far greater than the inequality of the disease itself. |
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Explain how dentistry has evolved over the years |
Dentistry has become more hightech with many technological advances. This often means its more expensive. Innovation has led to an increase in inequitable provision of dental care. Treatments are often limited by financial status of patients. Dentists are run like businesses |
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Explain the upstream and downstream metaphor |
Upstream= preventative, focuses on determinants of health, can reduce inequality, adresses source problem Downstream = treatments, rely on changing behaviours, tends to increase inequalities |
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Give examples of both upstream and downstream strategies to improve oral health |
Upstream = removing taxes on dental products, legislating sugar additives, limit advertising certain risk products, water fluoridation, education initiatives Downstream = telling a person to brush their teeth, see a dentist, cut back on sugar |
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Compare equity and equality |
Equity of access means access proportionate to need, not necessarily equal for everyone as equality suggests. |
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Study designs for teeth |
Cross sectional - scoping extent of health issue, monitoring populations Case controlled - investigating risk factors Cohort - investigating process/disease development, risk factors |
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Give 3 uses for prevalence data |
1.) Assessing the health status of a population 2.) Comparing impact of a condition among different populations 3.) Planning health services, gives indicators for further investiagtions |